Statement by Kenneth S. Apfel

News Release

Statement by Kenneth S. Apfel

Commissioner of Social Security

on SSI Childhood Disability Reviews

Good afternoon. Upon assuming office, I directed the Social Security
Administration to conduct a "top-to-bottom" review of the implementation
of the childhood disability provisions of the welfare reform law.
I believed that this review was needed because the Congress, the
President and the American public deserved to know whether the law
and the regulations were being applied fairly.

Today, I am releasing a report of the Social Security Administration's
review of cases of children who were affected by changes in the
law.

For the past two months, SSA has been examining quality assurance
data, developing case profiles, reviewing adjudicators' instructions
and conducting other oversight activities with this goal: to ensure
that our implementation process permitted every child who is eligible
for disability benefits to receive them.

Before discussing the results of the report, I think it is important
to note that there are approximately one million children receiving
SSI disability benefits. Of those one million children, only about
288,000 were subject to redetermination under the new law.

Our review found that overall SSA and the States did a good job
in the implementation of the childhood disability provisions of
the law; but we did find problems with the manner in which certain
redeterminations were made.

Most importantly, I want to emphasize that our review has not been
just about numbers--it has been about children. And because of that,
SSA is taking steps above and beyond normal action to assure that
every child receives a fair assessment of his or her benefit eligibility.
Today, I am directing the Agency and the State Disability Determination
Services to review approximately 45,000 of the SSI childhood disability
cases which were ceased during this process.

In addition, families of all children whose eligibility for SSI
has been ceased under the new law and who have not appealed will
receive another opportunity to do so.

Let me now outline the specific actions to be taken, and the
reasons for each.

The problems we identified generally fall into three areas: (1)
the status of children classified as having mental retardation;
(2) the actual case processing in some areas; and (3) confusion
regarding appeal rights.

Eighty percent of the children with mental retardation on the SSI
disability rolls were not subject to this review. Of the 80,000
children who were, over half were ceased. The question that needs
to be answered is why.

Part of the answer can be attributed to the fact that historically
some children who do not have mental retardation were actually coded
as having mental retardation. But we also found that some redetermination
decisions in mental retardation cases were wrong. In particular,
we were concerned that some children with mental retardation may
have been inaccurately ceased.

Therefore, I have directed that all benefit cessation cases showing
the mental retardation code be reviewed, as well as all denials
of initial applications filed on or after August 22, 1996. In addition,
for those children with the code for mental retardation and an IQ
score of 75 or below, we will reopen their case, develop it as needed,
and provide a new redetermination if their benefits were ceased
or their applications were denied. For those children with the code
for mental retardation and an IQ score above 75, we will review
their case and, if deficiencies exist, we will reopen it, develop
as needed, and provide a new redetermination.

Before these reviews begin, SSA will provide additional training
to its adjudicators on the mental retardation evaluation issues
raised in the report.

A second area of concern relates to the quality of our case processing
in some areas. Our quality reviews found that in most cases, the
case development practices were adequate and the decisions to either
continue or deny benefit payments were correct. However, there were
variations in accuracy rates. The review found that in some instances,
SSA did not follow or fully document all required contacts with
beneficiary families to enlist cooperation in processing the claim.

Also, while the accuracy of decisions has been above the regulatory
threshold for accuracy nationally, the Agency's quality assurance
data show that accuracy varies by state and by impairment.

Therefore, to ensure that each child's case was handled correctly,
I have directed the following action. In addition to the review
of all cases with the code for mental retardation, we will review
a portion of the cessation cases in those areas which have been
found to have the greatest likelihood of errors.

SSA will continue to monitor for quality assurance throughout the
review of these cessation cases.

The third area of concern focuses on confusion regarding our appeals
process and requests for benefit continuation. Concerns were also
voiced that beneficiaries did not receive information about the
availability of free legal services.

We found evidence which suggests that some beneficiaries and their
families who were ceased did not receive full information and did
not fully understand their rights. Because of that, I believe these
families deserve a second chance.

Therefore, I have directed the Agency to send special notices to
those families who were notified that a child had lost SSI eligibility
but who did not file an appeal. These families will be given another
opportunity to do so. And, if they should choose to appeal, they
will be given a new 10-day period to request benefit payments to
continue during the appeals process.

Families who did file an appeal but did not request continuation
of their benefit payments will also be given a new 10-day period
in which to request that benefit payments continue.

Also, SSA is making a concerted effort to ensure that families
are aware of available legal assistance by providing toll-free numbers
in our field offices, teleservice centers, our Internet site and
on the notices we send. We will include the numbers in our notices
in those States in which they are available.

Given the results to date of our initial redeterminations and the
actions outlined here today, I believe that the Agency's initial
estimate of 135,000 children losing benefit eligibility must be
modified. We now believe that about 100,000 children, approximately
10 percent of those who were receiving SSI benefits based on a disability,
will be impacted by the new law.

As I said at the beginning of my remarks, this review has been
about children. During the review we sampled 151 cessation cases
to help us answer the question "who are these children?" We found
that the children affected do have limitations in functioning, but
by and large, their conditions are not as severe as those of the
900,000 children who will continue to receive benefits. The majority
of cases in which children came off the rolls involved learning
problems, such as attention deficit hyperactivity disorder and conduct
disorders. A third of the children sampled had demonstrated medical
improvement.

This was an exhaustive process that received input from many people--advocates,
service providers, members of Congress and the public. We could
not have conducted this review without their support and I want
to personally thank them. I also want to take this opportunity to
say that this agency is doing all that it can to protect the rights
of disabled children.

Finally, let me say that I ordered this review because I wanted
a higher level of assurance that children are given every chance
to receive the benefits for which he or she is eligible under the
new law, and that is why I have announced these actions today. I
believe the actions will leave little doubt that the Social Security
Administration is committed to providing fair, thorough and equitable
reviews for all SSI childhood disability claimants and beneficiaries.